Volunteer Application

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1 Volunteer Application Thank you for your interest in volunteering with Nebraska Wildlife Rehab, Inc.! In order to qualify as a wildlife volunteer, please do the following: Complete all four pages of this application, including both releases. Mail your completed application to NWRI, PO Box 24122, Omaha, NE or scan and your paperwork to Submit your annual membership fee ($25 Individual, $40 Family, $50 Benefactor, $100 Patron). Once your application is received, a species team leader or board member will contact you to discuss available training dates for your training and certification. Please print the following information: Date of Application If renewing, what year did you start with NWRI? Name Occupation Address City State Zip Telephone (Home) (Cell) (Work) Birthday Children (Names and ages) Page 1 New Volunteer Application Ver. 2/2011

2 I am interested in the following volunteer positions: Wildlife Center Volunteer Animal Care Provider Rapid Response Team Cage Building & Repair Humane Society Transporter Other If you chose Animal Care Provider above, please complete the following section: Songbirds: Nestling Fledglings Injured Adult Waterfowl: Nestling Fledglings Injured Adult Opossums: Baby Juvenile Injured Adult Rabbits: Baby Juvenile Injured Adult Raccoons: Baby Juvenile Injured Adult Squirrels: Baby Juvenile Injured Adult Ground Squirrels: Baby Juvenile Injured Adult Bats: Baby Juvenile Injured Adult Large Carnivores: Baby Juvenile Injured Adult Reptiles All Miscellaneous Mammals: Baby Juvenile Injured Adult Please note: Nestling birds require feeding every half hour for approximately 12 hours daily. This intense schedule lasts 5-10 days. When running errands, missed feedings can be made up later in the evening. Fledgling birds must be taught to pick and eat on their own. Feedings are required every 1-1 1/2 hours initially, lessening in frequency as the bird learns to feed itself. I would also be willing to help with: Fundraising Publicity/PR Supply/Donation Pick-Up Education Newsletters Special Projects Membership Tracking Volunteer Coordination I own/rent land outside the city limits on which I would be willing to release the following species: Land location and owner: Do you have space inside to hold small cages (3 x3 x2 ) over the winter? yes no Do you have space for a 4 x8 x6 cage on your property? yes no Page 2 New Volunteer Application Ver. 2/2011

3 Please briefly detail your animal experience: Please use this space to provide any other information or comments you may have: Page 3 New Volunteer Application Ver. 2/2011

4 Page 4 New Volunteer Application Ver. 2/2011

5 Care Provider Agreement I am applying for care provider status with Nebraska Wildlife Rehab, Inc. (NWRI) which means that I will be able to handle wild animals for rehabilitation. The Game and Parks Commission of Nebraska will be given my name as a member who is approved to have wild animals in my possession. I understand that signing the following agreement does not obligate me in any way to care for wild animals, if I am at any time, unable or unwilling to do so. I have read and will obey the Nebraska Game and Parks Commission regulations (enclosed). I do not have a Game Fancier s permit. I understand that NWRI encourages me to carry personal liability insurance coverage in the event I am injured or anyone visiting my premises is injured by an animal in my care. Should I decide to rehabilitate a wild animal, I will follow the feeding/housing/medical/release procedures established and given to me by the appropriate team leader or board member. I understand that only members of the Board of Directors or others with prior Board approval, may speak to the media about the organization. This includes any person or organization which may publish or broadcast information about or photographs of NWRI or its animals. I will notify the appropriate team leader or a board member within 24 hours if I acquire a wild animal. I understand and acknowledge that my participation in NWRI is strictly as a volunteer and that I am not an employee or independent contractor of NWRI. I have read and executed the Volunteer Release Agreement. I understand that this agreement shall be in force as long as I am an active member, and that should I violate the foregoing agreement, my membership in NWRI may be terminated, or my status as a care provider revoked, in which case it will no longer be legal for me to handle wild animals. Signature Date Page 5 New Volunteer Application Ver. 2/2011

6 VOLUNTEER RELEASE AGREEMENT THIS AGREEMENT and RELEASE, dated this day of, 20, by and between Nebraska Wildlife Rehab, Inc., a Nebraska non-profit corporation (hereinafter referred to as NWRI), and, an individual (hereafter referred to as Volunteer ) or as parent(s) and/or natural guardian(s) of, minor child (hereafter referred to as Minor Volunteer aged 14 years or older ) or collectively referred to a Volunteers. WITNESSETH: WHEREAS, NWRI has been organized for the purpose of rescue, rehabilitation, and release of birds, fish, mammals, amphibians, and reptiles, and WHEREAS, in pursuit of its goals, NWRI obtains the assistance of Volunteers who participate in the wildlife rescue, rehabilitation, and release program sponsored by Nebraska Wildlife Rehab, and WHEREAS, due to conditions beyond the knowledge or control of NWRI, Volunteers may sustain injuries resulting from or in some way related to, their participation in said NWRI program. NOW, THEREFORE, for and in consideration of the mutual promises and covenants contained in this Agreement and Release, the parties hereto agree as follows: FIRST: The undersigned person(s) agree that they are the adult Volunteer or the parent(s) and/or natural guardian(s), having legal custody of Minor Volunteer(s). SECOND, in consideration of the opportunity afforded said Volunteers who participate in the Nebraska Wildlife Rehab program, hereby agree that they are assuming any and all risks concurrent with said participation and that Volunteers shall bear all financial and/or other burdens which may occur as a direct or indirect result of said Volunteers being injured in any way while participating in the NWRI program and that, under no circumstances, will Volunteer(s) present a claim or file a civil lawsuit against NWRI, it s Officers or Director s, and will hold NWRI, it s Officers or Director s harmless due to any loss or damages, of any type, sustained by Volunteer(s) as a result of Volunteer(s) participation in the NWRI program. THIRD: In an effort to minimize the likelihood of any injury to Volunteer(s), NWRI agrees to provide complete initial and supplemental instructions to Volunteer(s) with the respect to the rescue, rehabilitation, and release of any and all wildlife in the custody of said Volunteer(s). FOURTH: In the event that any Adult Volunteer(s) loses custody of a Minor Volunteer(s) during the term of this Agreement, then such Adult Volunteer(s) shall immediately notify NWRI, in writing, of such change in said Minor Volunteer(s) custodial or guardianship status. IN WITNESS WHEREOF, this Agreement is executed on the date and year first above written. Nebraska Wildlife Rehab, Inc By: Authorized Agent Volunteer Parent and/or guardian of the minor volunteer(s) listed in said Agreement. Page 6 New Volunteer Application Ver. 2/2011

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